Annual checkups are a good time to educate adolescents about sex, but not enough pediatricians are taking advantage of them.

Researchers analyzed the medical conversations between 253 adolescents (their average age was 14) and 49 physicians at 11 health clinics throughout the Raleigh/Durham area in North Carolina. After getting the participants’ permission to record their conversations, the team focused on any sex or sexuality-related topics — defined as any content involving sexual activity, sexuality, sexual identity or dating — discussed during the appointment.

They found that 65% of the visits did include some discussion about sexuality, but only in passing — the average time spent on these issues was 36 seconds. Only 4% of teens had prolonged chats with their doctors about topics related to sex, which suggested that most doctors were not discussing sexuality at all with their patients who were reaching sexual maturity during the yearly checkup.

More discussions occurred among female patients, older patients and African Americans. Asian physicians were less likely to have discussions about sexuality with their patients.

The annual checkups are therefore a missed opportunity for doctors to educate and answer their patients’ questions about sex and sexuality, say the authors of the study, which was published in the journal JAMA Pediatrics. Such discussions could also introduce teens to safer sex practices that could lower their risk of sexually transmitted diseases. More doctors should broach sexual behavior as a topic during the annual checkup, experts say, even if it’s uncomfortable for both parties. “Most adolescents think their physician is easy to talk to, are comfortable talking with their physician, and think their physician cares about them,” writes Bradley O. Boekeloo, a professor at the University of Maryland School of Public Health, in an editorial accompanying the study. “However, many adolescents feel uncomfortable talking with their physician about sexuality.”

Boekeloo notes that such awkwardness may only be one of the reasons that few doctors and patients are having these important conversations. The short amount of time that doctors have with their patients could be another, since sensitive issues surrounding sex and sexuality often require more in-depth and thoughtful interactions. And many doctors may feel there are other health priorities that are more important, such as vaccinations, drug and alcohol use, or emotional and behavioral problems — not to mention the basic physical exam. As primary-care physicians, they may feel ill equipped, or feel that it is not their primary role to have in-depth discussions about sex during their visits.

But increasingly, the medical community is urging primary-care personnel to devote more time to these topics. In November 2012, the American Academy of Pediatrics released a policy statement recommending that pediatricians discuss emergency contraception with teens and make it more available for those who are sexually active. The researchers are also studying the recordings in more depth to identify strategies for helping doctors to include more sex-related topics in their routine exams, and to find ways to train pediatricians to become more comfortable exploring these issues. Teens aren’t likely to initiate conversations about sex with their doctors, but they may be open to discussing questions or issues they have if their doctor asks.